Abdominal rigidity [Abdominal muscle spasm, involuntary guarding]
Abdominal rigidity [Abdominal muscle spasm, involuntary guarding]: Excerpt from Nursing: Interpreting Signs and Symptoms
Detected by palpation, abdominal rigidity refers to abnormal muscle tension or inflexibility of the abdomen. Rigidity may be voluntary or involuntary. Voluntary rigidity reflects the patient's fear or nervousness upon palpation; involuntary rigidity reflects potentially life-threatening peritoneal irritation or inflammation. (See Recognizing voluntary rigidity.)
Involuntary rigidity most commonly results from GI disorders, but may also result from pulmonary and vascular disorders and from the effects of insect toxins. Usually, it's accompanied by fever, nausea, vomiting, and abdominal tenderness, distention, and pain.
Action stat!
After palpating abdominal rigidity, quickly take the patient's vital signs. Although the patient may not appear gravely ill or have markedly abnormal vital signs, abdominal rigidity calls for emergency evaluation and interventions.
Prepare to administer oxygen and to insert an I.V. catheter for fluid and blood replacement. The patient may require drugs to support blood pressure. Prepare him for urinary catheterization, and monitor intake and output.
History and physical examination
If the patient's condition allows further assessment, take a brief history. Find out when the abdominal rigidity began. Is it associated with abdominal pain? If so, did the pain begin at the same time? Determine whether the abdominal rigidity is localized or generalized. Is it always present? Has its site changed or remained constant? Next, ask about aggravating or alleviating factors, such as position changes, coughing, vomiting, elimination, and walking.
Explore other signs and symptoms. Inspect the abdomen for peristaltic waves, which may be visible in very thin patients. Check for a visibly distended bowel loop or pulsations. Next, auscultate bowel sounds. Perform light palpation to locate the rigidity and determine its severity. Avoid deep palpation, which may exacerbate abdominal pain. Finally, check for poor skin turgor and dry mucous membranes, which indicate dehydration.
Medical causes
Abdominal aortic aneurysm
(dissecting).Mild to moderate abdominal rigidity occurs with a dissecting abdominal aortic aneurysm, a life-threatening disorder. Typically, it's accompanied by constant upper abdominal pain that may radiate to the lower back. The pain may worsen when the patient lies down and may be relieved when he leans forward or sits up. Before rupture, the aneurysm may produce a pulsating mass in the epigastrium, accompanied by a systolic bruit over the aorta. The mass stops pulsating after rupture. Associated signs and symptoms include mottled skin below the waist, absent femoral and pedal pulses, lower blood pressure in the legs than in the arms, and mild to moderate tenderness with guarding. Significant blood loss causes signs of shock, such as tachycardia, tachypnea, and cool, clammy skin.
Insect toxins.Insect stings and bites, especially black widow spider bites, release toxins that can produce generalized, cramping abdominal pain, usually accompanied by rigidity. These toxins may also cause a low-grade fever, nausea, vomiting, tremors, and burning sensations in the hands and feet. Some patients develop increased salivation, hypertension, paresis, and hyperactive reflexes. Children commonly are restless, have an expiratory grunt, and keep their legs flexed.
Mesenteric artery ischemia.A life-threatening disorder, mesenteric artery ischemia is characterized by 2 or 3 days of persistent, low-grade abdominal pain and diarrhea leading to sudden, severe abdominal pain and rigidity. Rigidity occurs in the central or periumbilical region and is accompanied by severe abdominal tenderness, fever, and signs of shock, such as tachycardia and hypotension. Other findings may include vomiting, anorexia, and diarrhea or constipation. Always suspect this disorder in patients older than age 50 who have a history of heart failure, arrhythmia, cardiovascular infarct, or hypotension.
Peritonitis.Depending on the cause of peritonitis, abdominal rigidity may be localized or generalized. For example, if an inflamed appendix causes local peritonitis, rigidity may be localized in the right lower quadrant. If a perforated ulcer causes widespread peritonitis, rigidity may be generalized and, in severe cases, boardlike.
Peritonitis also causes sudden and severe abdominal pain that can be localized or generalized. In addition, it can produce abdominal tenderness and distention, rebound tenderness, guarding, hyperalgesia, hypoactive or absent bowel sounds, nausea, and vomiting. Usually, the patient also displays fever, chills, tachycardia, tachypnea, and hypotension.
Nursing considerations
▪ Monitor the patient closely for signs of shock.
▪ Place the patient in a position of comfort.
▪ Administer analgesics, as ordered, and evaluate their effect.
▪ Withhold food and fluids.
▪ Administer an I.V. antibiotic as ordered if emergency surgery is required.
▪ Prepare the patient for diagnostic tests which may include blood, urine, and stool studies; chest and abdominal X-rays, computed tomography, magnetic resonance imaging, gastroscopy, and colonoscopy.
Patient teaching
▪ Explain diagnostic tests or surgery the patient will need.
▪ Tell the patient about any food or fluid restrictions.
▪ Show him how to position himself for comfort.
▪ Explain the underlying disorder and treatment plan.
Pictures
![Abdominal rigidity [Abdominal muscle spasm, involuntary guarding] - 5486.1.png](/bookimages/16/5486.1.png)
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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